腹腔镜下全直肠系膜切除术治疗低位直肠癌临床疗效观察

目的 探究腹腔镜下全直肠系膜切除术对治疗低位直肠癌临床疗效及优越性.方法 将86例低位直肠癌患者随机分为观察组和对照组,观察组给予腹腔镜下全直肠系膜切除术,对照组给予开腹全直肠系膜切除术,观察2组患者术后复发率、死亡率及手术效果.结果 2组复发及死亡率比较无显著性差异(P＞0.05),2组手术时间、清除淋巴结数目比较无显著差异(P＞0.05);观察组术中出血量及肠功能恢复时间均明显低于对照组(P＜0.05).结论 腹腔镜下全直肠系膜切除术治疗低位直肠癌安全可行,具有创伤小、术中出血量少、胃肠功能恢复快等优点,可作为目前治疗低位直肠癌的一种较佳手术方案.     

CT平扫与增强扫描在结直肠癌切除术中评估价值分析

目的结直肠癌临床较常见,需要通过手术切除治疗,术中进行有效的评估,利于手术顺利实施,本研究探讨CT平扫与增强扫描对结直肠癌切除术术前、术后评估的价值。方法选取2016-06-01-2018-06-01于鹤壁市中医院行结直肠癌切除术治疗80例结直肠癌患者为研究对象。比较80例结直肠癌患者CT检查肿瘤类型、病灶位置与手术或病理活检结果的符合率、CT检查T分期、N分期与手术或病理活检结果符合率,进一步分析CT检查对结直肠癌分期的效果。结果 CT检查肿瘤类型、病灶位置与手术或病理活检结果符合率均为100.00%;CT检查对结直肠癌T分期的灵敏度为78.43%,特异度为55.17%,准确率为70.00%,阳性预测值为75.47%,阴性预测值为59.26%;CT检查对结直肠癌N分期的灵敏度为56.67%,特异度为78.00%,准确率为70.00%,阳性预测值为60.71%,阴性预测值为75.00%。结论 CT平扫与增强扫描对结直肠癌定位定性准确率较高,TNM分期的灵敏度、特异度良好,在术前、术后评估中应用价值较高。     

全直肠系膜切除术治疗直肠癌的临床疗效观察

目的近年来直肠癌发病率有上升趋势,在临床治疗的过程中,采用全直肠系膜切除术越来越多。本文对全直肠系膜切除术和传统手术方法治疗直肠癌的临床疗效进行对比研究。方法选取双鸭山市宝清县妇幼保健院2011年4月-2014年4月治疗的直肠癌患者共60例,随机分为观察组和对照组,观察组采用全直肠系膜切除术(TME),对照组采用传统切除术。结果两组患者的手术时间、手术中出血情况、住院天数,以及患者术后各个阶段的生存率情况对比,观察组的情况优于对照组,差异有统计学意义(P0.05)。结论全直肠系膜切除术在临床治疗直肠癌的过程中效果明显,术后患者的生存率较高,减少了患者手术感染机会,缩短了手术时间,从这些方面来讲,手术方式优于传统治疗方式,在保证手术技术的情况下应该广泛推广应用。     

中低位直肠癌全直肠系膜切除术后吻合口瘘的临床分析

目的 探讨中低位直肠癌全直肠系膜切除术后吻合口瘘发生的因素.方法 回顾性分析2002年7月至2008年12月收治的401例中低位直肠癌患者行全直肠系膜切除术的临床资料,以及术后发生吻合口痿的治疗措施.结果 本组35例(8.73%)术后发生吻合口瘘,其中9例采用保守治疗,19例行结肠造瘘术,7例在保守治疗无明显疗效的情况下改行手术治疗.结论 吻合口瘘是全直肠系膜切除术后严重并发症之一,发生原因复杂,认识其发生的因素对于防治吻合口瘘非常重要.     

直肠癌直肠系膜筋膜受累的影像研究进展

直肠癌是常见的恶性肿瘤，恰当的影像学检查可以显示其发生部位、侵犯深度、累及范围、有无淋巴结或远处转移，为直肠癌分期、治疗方案的选择、判断预后提供主要依据。实施全直肠系膜切除术可以有效降低复发率，提高5年生存率，改善患者生活质量，这就为影像学检查提出了更高要求，现就直肠系膜筋膜的影像学研究现状及进展做一综述。     

直肠癌直肠系膜全切除术的临床病理依据及意义

目的 探讨直肠癌直肠系膜全切除术的临床病理依据.方法 对102例具有较完整临床病理资料行直肠癌直肠系膜全切除术直肠癌组织、癌旁组织、直肠系膜进行常规病理切片,分析直肠系膜与直肠癌的分化程度、临床分期、淋巴结转移的关系及治疗效果.结果 直肠系膜癌转移均与癌组织分化程度、临床分期、淋巴结转移有相关性(P<0.05).结论 直肠癌直肠系膜全切除术是治疗直肠癌的最佳途径,切除的直肠系膜的范围应根据Dukes分期、肿瘤的分化程度及肿瘤浸润肠壁的深度区别对待.     

全直肠系膜切除术治疗中低位直肠癌的临床疗效观察

目的分析比较全直肠系膜切除术和传统手术方法治疗中低位直肠癌的临床疗效。方法选取2006年1月至2011年1月间我院收治的并行全直肠系膜切除术治疗的中低位直肠癌患者30例为观察组,以及同期行传统手术切除治疗的中低位直肠癌患者30例为对照组,比较两组治疗的临床效果。结果两组间患者在吻合口瘘发生率和住院时间上比较,差异无统计学意义（P〉0.05）,观察组在手术时间、术中出血量、术后感染以及局部复发率方面得到显著改善,患者5年生存率显著提高,两组间比较,差异均具统计学意义（P〈0.05）。结论全直肠系膜切除术较之传统手术方法治疗中低位直肠癌具更好的临床效果,能显著降低术后的局部复发率,提高患者的生存率,改善患者生活质量。     

中低位直肠癌行全直肠系膜切除保肛治疗临床分析

目的探讨中低位直肠癌全直肠系膜切除行保肛手术的临床效果。方法观察组67例行全直肠系膜切除术、对照组50例采用传统手术方法治疗,对两组患者的手术时间、术中出血量,术后吻合口瘘、局部复发及生存率进行比较分析。结果两组比较术后吻合口漏发生率无显著差异(P0.05),而手术时间、术中出血量、术后1年复发率和5年生存率方面观察组明显优于对照组(P0.05)。结论全直肠系膜切除治疗中低位直肠癌,手术时间短,术中出血量少,可有效降低术后肿瘤复发率,提高患者生存率。     

腹腔镜和开腹全直肠系膜切除术治疗直肠癌患者短期疗效观察

目的：分析腹腔镜和开腹全直肠系膜切除术治疗直肠癌患者短期疗效。方法：收集我院2011年1月一2012年1月期间诊治的直肠癌患者50例作为研究对象,采用随机分组的方式将患者分为观察组与对照组,每组患者各25例。对照组采用传统开腹全直肠系膜切除术治疗,观察组在腹腔镜下治疗,对两组患者的临床效果进行分析对比。结果：观察组患者的并发症发生率明显低于对照组,术中流血量明显少于对照组,手术时间和住院时间明显短于对照组,短期生存率明显高于对照组,两组数据结果比较具有明显差异（P〈0．05）。结论：腹腔镜全直肠系膜切除术治疗直肠癌患者的短期疗效优于传统开腹手术,值得在临床应用上推广。     

保留盆腔神经的直肠癌根治术的护理

随着淋巴结扩清范围的扩大及全直肠系膜切除术的应用进展,直肠癌的生存率已有明显改善.但另一方面,大范围的淋巴结清扫及全直肠系膜完整切除,已使许多患者的泌尿及生殖功能受到不同程度的影响.为了改善直肠癌患者术后的生活质量,尽可能地使患者泌尿系统及生殖功能维持正常,近年保留盆腔自主神经的直肠癌根治术(pelvic autonomic nerve preservation,PANP)已逐渐开展.本院普外科自2000年9月～2002年10月采用PANP为26例患者施行手术治疗,取得了良好效果,现将有关护理体会介绍如下.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.